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I can hike uphill practically all day. However as very soon after I start a descent, pain builds on the outside of my knee. What is causing this and can I do anything to prevent/mitigate it (other than Ibuprofen)?

Edit: I talked to my doc and the location of the pain is very important in the cause. Note that this is pain on the outside (side) of the knee specifically, as opposed to pain in the knee or below/under the kneecap.

I have just completed a 20 km walk called the Tongariro crossing. Its in new Zealand. Lots of steps going up and also going down. Did a reasonable amount of pre training by walking flat and steep.up and down. I was in severe pain on outside of both knees coming down hill. Steps were negotiated sideways and using a pole and one at a time. Slowed progress to a point where you may well be spending a night out in the bush if distance was any longer and daylight shorter. Looks like the correct preperation is the only answer. I am an active 66 year old and never had this before. Thanks for the advic
– user9177Mar 30 '16 at 3:04

12 Answers
12

Talked to my doc today during a visit for something else. It's Iliotibial Band Syndrome. The band of connective tissue that runs along the outside of the knee becomes irritated and inflamed. It's often caused by over-pronation and poor gait which is exacerbated on the weight bearing leg (not the landing leg) when going downhill. Once injured, the only good solution is rest and anti-inflammatory medication while it heals.

There are specific exercises and stretches that will work to prevent the injury. Specifically you have to stretch the band itself and build the muscles above the knee

Pain from excess force on the downhill would usually present below or in the kneecap, not to the side.

I am not a doctor. But I have found a solution to my knee pain (which I think might be the same area): a lot of leg strength exercise. If my quads are strong enough, I can walk down hill (with a heavy pack on), landing heel first. This takes the pressure of my knee, and I can walk faster. Again, I am not a doctor.
– theJollySinDec 16 '13 at 17:10

1

Also, I've learned that preemptively putting an ace bandage or similar brace around my knee helps my knees feel way better after a really long hike, especially in a mountaineering environment.
– BlackbearJun 23 '14 at 19:14

"Specifically you have to stretch the band itself and build the muscles above the knee" This is actually false, you can't stretch the band any more than you can stretch tire rubber, the issue is in your glutes and your tensor fascia latae (the muscles that attach to your IT band from you hip) It's those muscles which need strengthening. The rest of your issues are in the facia (the "sausage sleeve" that wraps around your leg, your ITB is actually nothing more than the thickest part of the facia in your leg), it's "glued" to the tissues below it, you need to get it "unglued".
– ShemSegerSep 2 '15 at 14:37

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I've had that for a long while now. Mainly caused by carrying those heavy backpacks during trekkings. I never feel it until I'm going downhill again! My doctor had told me the same, plus cycling which would strengthen those thingies around the knee cap, without putting the body's pressure/weight on it. I've done that a lot and don't hike as often anymore, but it's still there. Wearing a knee cap support (of the right type) is very very helpful.
– NeekuSep 11 '16 at 7:46

I have experienced the same when trail running.
I can pretty consistently reproduce the symptoms on downhill stretches when running distances that are much longer than my regular runs, when starting to hit the trails again after not running for a while, and when running downhill at a faster pace than I would run uphill.

The following is my hypothesis, meaning I don't have any published facts to back this up:

When going uphill we are fighting gravety in a pretty static way. It is not likely that we would go any faster or for longer distances than our muscle-mass permits.

When going downhill on the other hand, we have momentum that our muscles have to slow down. Fightling gravety becomes less static and more dynamic, especially with steeper slopes and higher speeds. We can keep going even when our muscles are fatiguing, and we can go faster than our muscles can effectively slow down, which passes the stress of slowing down on to our skeletal system (mainly our joints.) This can be compounded by heavy heal-striking (less cushioning by our muscles) and a heavy pack (providing a larger mass, which increases the momentum.)

My advice would be to take downhill stretches at a much slower pace (on my trail runs I am MUCH slower going downhill than uphill!), avoid steep slopes until you build up the specific muscles you use for descending, don't take as much stuff when moving on steep terrain and transition to a midd-foot-strike when you notice your knee is hurting (a word of caution: practice this! If you are a heavy heel-striker this can be very tiring for your calfs and you can damage your achilles-tendon if you don't strengthen it first.)

I take this kind of pain pretty seriously. To me it is a sign that even though I have the conditioning, I am missing the muscles to do what I am doing when my knees hurt.

I've had this, too. You're just stressing different ligaments than when traveling uphill. I think it's a matter of getting the right exercise, which is to say, do the same thing on training hikes.

I've also experienced pain in that area after crossing an ice-cold creek, then hiking after. Alleve is my drug of choice since I can take it at the beginning of the day and it lasts all the way through.

I just got back from hiking Inyo county Bishop Ca. area call Sage flat and when coming down my outside knees began to hurt and by the time we got down it was hard to take steps. I hoped over night it would feel better so i could hike the next day, It did and we decided to take the lower trail which is flatter but again coming back i started to feel my knee again this time I met a hiker who was wearing nylon knee brace, the are a pull on over the knee with a hole over the knee bone with boning for support on the side he said they help him. also he said take a mussel relaxer if it gets bad and poles help too. today I made it back down taking slow wider steps lifting my leg at the knee higher that helped. Good luck and good hiking.

You are experiencing a strain of the LCL, the Lateral Collateral Ligament that connects your femur to your fibula with IT Band syndrome. The mechanics of going downhill when hiking are significantly different than up. When taking a step down from a height of more than 6 inches, the femur tends to stay perpendicular to the ground, under the hip joint while the knee flexes and the ankle(point of contact) is well behind the bending knee joint, putting strain on the knee ligaments and the IT band to assist. If you notice when this happens, the affected knee, let's say the left knee, may be unable to support your weight- but twisting your body to the left as you step down, keeping your ankle directly under your knee joint and lowering your body to contact the ground will not be painful. It's due to the mechanics of the downhill hiking- sending the point of contact(ankle) behind the knee. Twist and keep your ankle under your knee- no strain/pain.

The same thing can happen while squatting during weight training. During a weightlifting squat movement, your knee joint should never drift in front of your ankle joint. The hips should always flex during the squat, which keeps your knee directly over your ankle. If you squat down and your knees are shooting in front of your ankles, not only are you reproducing this downhill hiking mechanic you are risking injury to the knee.

Icing after a long hike can only help you the next time you go out. Also be certain you aren't battling other imbalances of the hips and legs. When you lay down, do your toes turn way out to the side or point straight up? If they turn to the side(supination/external rotation of the knee), your hip abductors are too tight while your adductors are too weak.

Visit a physiotherapist, and take your current shoes -- both the ones you use on trips, and the ones you wear every day. A good physio can learn a lot from reading the wear patterns on your shoes.

If you go to a doc, go to a sports doc. Call the coach at your local high school or college and ask who's good.

Part of the problem is sudden shocks, Learn to keep a spring in your step going down hill. This will usually mean slowing down. One technique I've used is to take rapid, but very short steps. This doesn't work in big talus, or trails with lots of roots and holes. Land on a bent knee.

In addition to the various stretches and strenthening routines, get ready for trips by going to your local skyscraper, large stadium or river valley park, and do stairs. Lots and lots of stairs. This is where you practices you bouncy springy stride.

When walking uphill, your hips, knee and ankle flex, which reduces the effective stiffness of the articulated leg (i.e increases the 'springiness' of the gait). When going downhill, we tend to use both a more straight-legged gait with a more pronounced heelstrike, which increases the stiffness of the articulated leg (i.e reduces the 'springiness' of the gait). Indeed, while walking on the flat on a hard surface can induce peak forces of three times body weight (3BW) at the base of the spine, going down hard surfaces such as concrete steps, can induce peak forces of the order of 10BW.

It's a problem with the momentum that your body builds up. While going uphill, you exert force to climb. And the gravity tries to pull you down. While going downhill though, the gravity still pulls you down. Now your body builds up a higher momentum and the default action of your brain is to arrest this momentum(Else you will end up running at an ever increasing pace while going downhill). This means that the force on knees is significantly higher. This is the reason why you might face some pain in your toes as well. Toe and knee take the brunt of the "slow-down" functionality. It's quite normal and the effect is reduced if you take a sideways path than a straight down one. Also walking slow does help. Again, the answer lies in physics.

I've experienced a lot of side knee pain over a 20 year period of hiking, jogging, walking. The pain is/was always associated with the foot impact. I could jog about 3 miles before it would start, or I could hike about 6 miles with up and down sections before it would start. I was told that it was my IT band, but no one every gave me a satisfactory solution.

Then a friend was starting up a health/fitness retreat resort and wanted some "guinea pigs" to iron out the wrinkles with the staff and classes. In one of those classes, we used a runner's roller to work out muscle kinks and knots. I was told that it would help alleviate my condition by using the roller.

It has helped. After using a roller for about a week, I have been able to run/jog about 10 miles, hike 11 miles or more without any of the pain I had previously experienced.

I have recently been experiencing the pain again, but I would have to say it's because I haven't been using the roller lately. Probably been building up a lot of kinks and knots over the years.

I rolled the outer leg muscles. It hurts like hell because of the kinks and knots. Definitely a low cost solution (about $25) that is worth a try.

It is best for you to visit a physiotherapist and ask for proper shoes for running. In most cases, (I’ve read from other running communities) your running shoes are a big factor if you are experiencing knee pain while running. If the pain persists, seek for other options like knee surgery.

I removed your link as that looks a bit too much like link spam. I also downvoted as my question asks about hiking, not running. Your answer is both incorrect and not relevant to the question at hand.
– Russell SteenOct 25 '15 at 15:08

There are a lot of options to consider before surgery.
– ab2Feb 5 '16 at 18:37

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